Understanding Etiopathogenesis, Pathophysiology, Diagnosis and Innovative Approaches to Management of Infantile Colic: A Narrative Review of the Literature and Multi-center Experience

Abstract Objective: Infantile colic is a common functional gastrointestinal disorder characterized by excessive crying in otherwise healthy infants. This review synthesizes current evidence on epidemiology, etiopathogenesis, pathophysiology, diagnostic criteria, and management strategies in the light of our multicentre international evidence based long term experience. Design: Narrative review of published systematic reviews, meta-analyses, and guidelines through the lens of evidence based multinational multicentre broad based experience. Results: Prevalence varies widely (2–73%), reflecting heterogeneous diagnostic criteria. Pathophysiological hypotheses include psychosocial stress, neurodevelopmental immaturity, immature gastrointestinal motility, and gut dysbiosis. Diagnosis remains clinical, based on Rome IV criteria and exclusion of organic disease. Management emphasizes parental reassurance, behavioral interventions, and selective use of probiotics (Lactobacillus reuteri DSM 17938). Pharmacological agents such as simethicone and proton pump inhibitors show little benefit. Conclusions: Infantile colic is best managed through parental support and evidence-based interventions such as holobiotics, laxatives and broad-spectrum nutritional supplements . Future research should prioritize microbiome-targeted therapies and harmonized diagnostic frameworks.